OF mental health care and mentally ill

Gender identity disorder treatment

Psychological therapies Most people with gender identity disorder are resistant to psychotherapy. As a result, there are no clinical trials reporting attempts to change gender identity. However, a number of case reports indicate that behaviour and attitudes can be changed should the individual wish, or even when they do not seek help. Meyer-Bahlburg argued that young people often experience ostracism from peers and even other family members and other social diffi culties, which can lead to them dropping out of school and experiencing signifi cant emotional problems. They argued that therapy was therefore justifi ed ‘to speed up the fading of the cross-gender identity which will typically happen in any case’. Meyer-Bahlburg worked with parents of eleven young people to modify key factors known to be associated with the persistence of gender identity disorder. Therapy was conducted through the parents, who attended sessions in the absence of the young person. These involved developing strategies to, for example, increase time spent between father and son, and decrease time with mother; distraction from cross-gender behaviour rather than prohibition, increased attention to gender-typical behaviour, identifying suitable male peers for play dates, and as the boy gains peer-relational skills, joining male social groups such as the scouts or sports teams. They report a number of successful case histories.

Many people with gender identity disorder request sex reassignment surgery. This involves a complex, staged process. For male-to-female transitions, treatment starts at least a year before surgery. First, the individual starts taking the female hormone oestrogen that results in a number of physical changes, including the development of breasts and a softening of the skin. Fat may shift from the shoulders to the hips in feminine fashion.